{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:26Z","timestamp":1784557046092,"version":"3.55.0"},"reference-count":12,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"\n Summary<\/jats:title>\n \n Tumor-induced osteomalacia (TIO) is a rare form of osteomalacia caused by fibroblast growth factor-23 (FGF23)-secreting tumors. Most of these tumors are phosphaturic mesenchymal tumors (PMTs) typically involving soft tissue in the extremities and bone of the appendicular skeleton and cranium. We report the case of a 60-year-old woman with about 3 years of persistent bone pain and multiple fractures, initially diagnosed as osteoporosis, who was found to have hypophosphatemia with low 1,25-dihydroxyvitamin D and elevated alkaline phosphatase and inappropriately normal FGF23 consistent with TIO. Her symptoms improved with phosphate supplementation, vitamin D and calcitriol.\n 68<\/jats:sup>\n Ga-DOTATATE imaging revealed a T12 vertebral body lesion confirmed on biopsy to be a PMT. She underwent resection of the PMT with resolution of TIO and increased bone density. This rare case of TIO secondary to a PMT of the thoracic spine highlights some of the common features of PMT-associated TIO and draws attention to PMT-associated TIO as a possible cause of unexplained persistent bone pain, a disease entity that often goes undiagnosed and untreated for years.\n <\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Tumor-induced osteomalacia (TIO) is typically caused by phosphaturic mesenchymal tumors (PMTs) that are usually found in the soft tissue of the extremities and bone of the appendicular skeleton\/cranium and rarely in the spine.<\/jats:p>\n <\/jats:list-item>\n \n TIO may be misdiagnosed as osteoporosis or spondyloarthritis, and the correct diagnosis is often delayed for years. However, osteoporosis, in the absence of fracture, is not associated with bone pain.<\/jats:p>\n <\/jats:list-item>\n \n The hallmark of TIO is hypophosphatemia with inappropriately normal or low 1,25-dihydroxyvitamin D and elevated or inappropriately normal fibroblast growth factor-23 (FGF23) levels.<\/jats:p>\n <\/jats:list-item>\n \n In patients with unexplained persistent bone pain, a serum phosphate should be measured. Consider PMT-associated TIO as a potential cause of unexplained persistent bone pain and hypophosphatemia.<\/jats:p>\n <\/jats:list-item>\n \n \n PMTs express somatostatin receptors and may be identified with\n 68<\/jats:sup>\n Ga-DOTATATE imaging.\n <\/jats:p>\n <\/jats:list-item>\n \n Complete surgical resection is the preferred treatment for spinal PMTs associated with TIO.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-22-0344","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T07:01:15Z","timestamp":1670396475000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":3,"title":["Tumor-induced osteomalacia treated with T12 tumor resection"],"prefix":"10.1530","volume":"2022","author":[{"given":"Alyssa J","family":"Mancini","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Sabet","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine, Boston, Massachusetts Division of Endocrinology, Department of Medicine, St. Elizabeth\u2019s Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnlaugur Petur","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Anthony","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph H","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim S","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-573X","authenticated-orcid":true,"given":"Alan O","family":"Malabanan","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine, Boston, MA Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Modern Pathology","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1038\/s41379-018-0100-0","article-title":"Phosphaturic mesenchymal tumor with an admixture of epithelial and mesenchymal elements in the jaws: clinicopathological and immunohistochemical analysis of 22 cases with literature review","volume":"32","author":"Wu","year":"2019","unstructured":"Wu HBui MMZhou LLi DZhang HZhong D. Phosphaturic mesenchymal tumor with an admixture of epithelial and mesenchymal elements in the jaws: clinicopathological and immunohistochemical analysis of 22 cases with literature review. Modern Pathology201932189\u2013204. (https:\/\/doi.org\/10.1038\/s41379-018-0100-0)10.1038\/s41379-018-0100-0"},{"key":"bib2","series-title":"Seminars in Diagnostic Pathology","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1053\/j.semdp.2019.07.002","article-title":"Phosphaturic mesenchymal tumors: a review and update","volume":"36","author":"Folpe","year":"2019","unstructured":"Folpe ALPhosphaturic mesenchymal tumors: a review and update. Seminars in Diagnostic Pathology201936260\u2013268. 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